Aspirin Helps in Reducing Cancer Deaths, a Study Finds

Many Americans take aspirin to lower their risk of heart disease, but a new study suggests a remarkable added benefit, reporting that patients who took aspirin regularly for a period of several years were 21 percent less likely decades later to die of solid tumor cancers, including cancers of the stomach, esophagus and lung.

As part of the new study, published online Monday in the journal Lancet, researchers examined the cancer death rates of 25,570 patients who had participated in eight different randomized controlled trials of aspirin that ended up to 20 years earlier.

Participants who had been assigned to the aspirin arms of the studies were 20 percent less likely after 20 years to have died of solid tumor cancers than those who had been in the comparison group taking dummy pills during the clinical trials, and their risk of gastrointestinal cancer death was 35 percent lower. The risk of lung cancer death was 30 percent lower, the risk of colorectal cancer death was 40 percent lower and the risk of esophageal cancer death was 60 percent lower, the study reported.

The specific dose of aspirin taken did not seem to matter — most trials gave out low doses of 75 to 100 milligrams — but the participants in the longest lasting trials had the most drastic reductions in cancer death years later.

“This is important as a proof of principle that a single simple compound like aspirin can reduce the risk of cancer substantially,” said the study’s lead author, Dr. Peter M. Rothwell, professor of neurology at the University of Oxford. “There’s been a lot of work over the years showing that certain compounds can increase the risk of cancer, but it’s not been shown before that we can reduce the risk with something as simple as aspirin.”

But even as some experts hailed the new study as a breakthrough, others urged caution, warning people not to start a regimen of aspirin without first consulting a doctor about the potential risks, including gastrointestinal bleeding and bleeding in the brain (hemorrhagic strokes).

“Many people may wonder if they should start taking daily aspirin, but it would be premature to recommend people starting taking aspirin specifically to prevent cancer,” said Eric J. Jacobs, an epidemiologist with the American Cancer Society.

While Dr. Jacobs said the study design was valid, relatively few women were included in the trials, making it difficult to generalize the results to women.

“It’s hard to assess effects on mortality from just one study,” he said.

The findings do not come entirely as a surprise, Dr. Rothwell said, because aspirin has been found to slow or prevent the growth of tumor cell lines in the laboratory. Observational studies have reported that people who took aspirin were at lower risk for colorectal cancer recurrences, while other studies have pointed to similar reductions in cancers of the lung, stomach and esophagus.

“There have been hints of this before, but the quality of this study is the gold standard because it is based on randomized clinical trials,” said Dr. Alan A. Arslan, an assistant professor of obstetrics and gynecology and environmental medicine at New York University School of Medicine, who did an observational study several years ago reporting that women who had taken aspirin regularly had a lower risk of ovarian cancer. “Randomized controlled trials carry more weight.”

The strong results “add to the accumulating evidence that aspirin may be protective against various cancers,” Dr. Arslan said.

There are several ways in which aspirin may work to slow the development of cancers, experts say. Inflammation may play a role in cancer, and aspirin blocks the synthesis of prostaglandins, which are mediators of inflammation, and may affect early tumor promotion.

Aspirin may also induce the death of early cancer cells before they become aggressive, Dr. Arslan suggested.

Pune meningitis vaccine for Africa to make debut at home soon

NEW DELHI: The path-breaking vaccine that is helping rid Africa of meningitis will be available in India soon.

Punes Serum Institute, which created MenAfric-Vac will apply for license to Drug Controller General of India (DCGI) shortly, to make the one-shot vaccine available in India.

The phase-III human trials of the vaccine on 823 people (5-10 years) -- reports of which are being put together for submission to DCGI -- found over 90% protection profile.

Serum Institute's Dr Prasad Kulkarni, who conducted the vaccine trials, told ToI from Pune that the meningococcus bacteria has about five serotypes A,B,C,Y and W. The serotype A meningococcus bacteria accounts for an estimated 80% of all cases in the meningitis belt -- with epidemics occurring at intervals of 7-14 years.

"This same type of bacteria -- serotype A -- causes outbreaks in India. The vaccine being used in Africa is perfect for India. We will apply for marketing license to the DCGI soon. We have conducted three trials of this vaccine in India. Phase-I was done on 74 healthy adults, PhaseII on 600 and Phase III on 823. The protection rate is always above 90% with minor sideeffects like injection site pain," Dr Kulkarni said.

He added, "Till date, India never had a conjugate vaccine. It only used meningococcal polysaccharide vaccines during large outbreaks to arrest the spread. However, the problem with non-conjugate vaccines are that it does not result in herd immunity, does not protect children below two years and its effects is not long lasting."

In the last year's epidemic, 14 African countries, implementing enhanced surveillance, had reported 88,199 cases of meningitis, including 5,352 deaths -- the highest since a 1996 outbreak.

Serum Institute, which took more than 10 years to develop the vaccine, is being used in 25 African nations -- from Ethiopia to Senegal -- that fall under the region's infamous meningitis belt. The vaccine costs less than 50 cents.

"We believe it will protect those vaccinated for two decades, and also cause herd immunity. This means it will provide long-term protection, and induce immunity in certain non-vaccinated persons, who live in proximity of those who are immunised, leading to broad community protection," Dr Kulkarni added. The countrywide vaccination of the population in the 1-29 age group kicked offin Burkina Faso on Monday.

Interestingly, MenAfriVac costs less than one-tenth of $500 million usually required to develop and launch a new vaccine in the market.

For more than 100 years, sub-Saharan Africa has suffered from meningitis epidemics. As many as 450 million are at risk from the disease across Africa. Typically, critical patients die within 24 to 48 hours of the onset of symptoms, and among the survivors around 10%-20% suffer brain damage, hearing loss or learning disability.

Developed by the Meningitis Vaccine Project (MVP) -- a partnership between the World Health Organization (WHO) -- and PATH, an INGO, with support from the Bill & Melinda Gates Foundation -- the new meningococcal A conjugate vaccine MenAfriVac has several advantages over the ones being used to combat meningitis epidemics in Africa. It protects one-year-old babies. It is expected to both protect from the disease for significantly longer than the vaccine being used to combat epidemics, and to reduce infection and transmission. Reduced transmission, in turn, protects the larger community, including family members and others, who have not been immunised.

Approximately 300 million will be targeted for mass vaccination across the meningitis belt, with the entire population (an estimated 450 million) then protected through the broader community protection that could reduce transmission of the disease.

Beating heart transplants tested

Andrea Ybarra's donated heart was beating rhythmically by the time she awoke from the grogginess of her surgery.

Lub-dub. Lub-dub. Lub-dub. In fact, it was warm and pumping even before doctors transplanted it.

Ybarra belongs to a small group of people who have had a "beating heart" transplant, an experimental operation that's mostly been done in Europe. The donor heart is placed into a special box that feeds it blood and keeps it warm and ticking outside the body.

"I felt peaceful when I woke up. I wasn't scared," recalled the 40-year-old from Los Angeles who suffers from lupus. "It felt like the heart was a part of me all the time."

Despite advances in heart transplantation, the way hearts are moved around the United States and most places remains low-tech.

A team of doctors and organ recovery specialists stuffs an off-the-shelf picnic cooler with ice and jets off at odd hours to a donor hospital where a heart from a brain-dead patient awaits. They inject a chemical to stop the organ and preserve it in the ice chest for the trip home.

Once a heart is harvested, it's a race against time. A heart can stay fresh in the cooler for 4 to 6 hours before it starts to deteriorate. Because of this constraint, doctors can't travel too far to heart-hunt.

It's been done this way for more than four decades, ever since the first U.S. heart transplant was performed on Dec. 6, 1967.

Research has shown that the longer it takes to remove a heart and transplant it, the greater the patient's chance of death or heart disease.

But what if a heart could beat on its own after removal from a cadaver?

It may sound a bit macabre, more like an Edgar Allan Poe story. The new high-tech heart box circulates blood from the donor to the heart so that it continues throbbing while in transit from hospital to hospital.

Based on some success overseas, the University of California, Los Angeles is currently heading an experiment along with several other schools that compares the safety and effectiveness of the new preservation method versus the standard cooler.

If the new technology succeeds in preserving hearts longer, it could change the field, experts say.

No longer will patients be limited by location. Doctors could make cross-country heart runs without worrying about how long it takes. Hearts are now given first to people on the waiting list who live near where the donor is hospitalized. If there's no match, then the circle widens until a recipient is found.

"The rush factor will be taken out. I can go all the way to the West Coast to get a heart," said Dr. Bruce Rosengard ofMassachusetts General Hospital, who performed the first beating heart transplant in the United Kingdom in 2006.

It may also potentially help ease the organ shortage crisis. Some 3,000 Americans are currently on the heart transplant waiting list. Last year, 359 died waiting for a heart — almost one person a day.

The thinking is that hearts may be in better condition if they're kept beating instead of being cooled in ice. And if hearts can be monitored outside the body, proponents say this may help increase the organ pool by allowing less-than-perfect hearts to be transplanted.

Ybarra's surgery began like any other. The call came in to Ronald Reagan UCLA Medical Center shortly before 4 p.m. on Aug. 24. There is a heart available. Do you have a match?

The transplant team dialed Ybarra. Her lupus, an immune system disease in which the body attacks its own organs, had ravaged her heart, leaving it enlarged and weak. She desperately needed a transplant.

The following day, a brigade of doctors and technicians set off before dawn by limo to the Van Nuys Airport to board a private jet to the donor hospital in the Palm Springs area east of Los Angeles.

Since Ybarra signed up to be part of the beating heart experiment, she had a 50-50 chance of having the new operation.

Before the team left, a nurse practitioner drew a card at random: Ybarra was getting the experimental heart transplant.

The doctors arrived at the donor hospital at 6:20 a.m. and cut open the patient's chest an hour later. After examining the heart, they stopped it to remove it. Instead of packing the heart on ice, doctors transferred it to a box filled with blood and nutrients to revive it. The box was then tucked inside a portable machine for transport.

On the way back to UCLA, the heart was closely checked to make sure it was stable.

In the meantime, Ybarra was wheeled into the operating room and put under. She was placed on a heart-lung machine as doctors took out her failing heart. The new one was ticking nearby. Surgeons re-stopped the donor heart and sewed it into Ybarra. As her own blood coursed through, it began to pound.

All told, the donated heart had been beating in the box for a little over three hours.

If a heart can survive outside the body longer than the current limit, heart transplants may someday be less an emergency procedure and more like an appointment that can be scheduled — a convenience for both patients and doctors.

"If you knew an organ could be preserved, instead of doing a transplant at 3 a.m., you can push it back to 6 a.m.," said UCLA's Dr. Richard Shemin, who performed Ybarra's operation on his 39th wedding anniversary.

The world's first beating heart transplant was performed in Germany in 2006, using an organ box invented by TransMedics Inc., a private medical device company in Andover, Mass., as part of a multi-center study in Europe.

The company followed up with a pilot study in the U.S. It is currently funding the UCLA-led experiment, which will enroll 128 patients nationwide, randomly chosen to get a beating heart transplant or the traditional kind.

About 100 patients, mostly in Europe, have had a beating heart transplant, according to TransMedics.

Early signs from two European experiments involving 54 patients are encouraging. There has been 97% survival a month after the operation and few episodes of rejection and heart-related complications. But since there were no comparison groups in either study, it's impossible to know whether a beating heart transplant is actually better.

The current U.S. study is the first to test the methods head-to-head.

Doctors admit some patients are spooked by the idea of a heart beating on its own before the transplant.

"It's very difficult to remedy their anxiety. But when you think about it, the human heart was never meant to be in a cooler on ice," said lead investigator Dr. Abbas Ardehali of UCLA. TransMedics paid his travel expenses to a medical meeting, but he does not have other financial ties to the company.

Transplant doctors with no connection to the research note that the current system works despite the antiquated way hearts are carted around. Before beating heart transplants can be routine, researchers must not only prove that the technology can preserve hearts better and longer, but that recipients also have improved survival and health than if they had a regular heart transplant.

"In theory, it's a fabulous idea," said Dr. Stuart Russell, heart transplant chief at Johns Hopkins University. But more data is needed to determine whether "it will or won't fly."

There's also the issue of cost. A typical heart transplant in the U.S. costs about $787,000 including hospital stay and anti-rejection drugs. An Igloo cooler costs $35 compared with the heart box, which is sold in Europe for about $200,000. The interior is not reusable so there's an added expense each time a hospital does such an operation.

Like other transplant recipients, Ybarra was monitored closely after her August surgery to make sure her body wasn't rejecting the foreign organ. Her health slowly improved. She could walk around the block without getting tired — a small victory for someone who couldn't even take a few steps before.

During a recent checkup in October, Ybarra laid on a table as a doctor snaked a thin tube into her jugular vein and removed small pieces of her heart for a biopsy. She then walked over to her cardiologist's office where she got the scabs on her chest checked out.

Her last stop was getting an echocardiogram, a sonogram of the heart.

It looked normal.

72,000 pounds of canned chicken salad recalled

The discovery of hard plastic inside packages prompted a nationwide recall of 72,000 pounds of canned chicken salad, one of several recalls involving poultry and meat products issued through U.S. food safety authorities in recent days.

The Suter Company is recalling 8.2-ounce packages of the "Bumble Bee Lunch on the Run Chicken Salad Complete Lunch Kit" and 3.5-ounce packages of "Bumble Bee Chicken Salad with Crackers," according to a statement released Sunday by the U.S. Department of Agriculture's Food Safety and Inspection Service.

While the company is headquartered in Sycamore, Illinois, its products are sold from coast to coast. The recalled products -- which have a August 2011 "best-by" date for the lunch kit, and February 2012 corresponding date for the cracker package -- were put together and shipped out to distributors and stores between August 14 and 28 of this year.

The recall was prompted by complaints from people who found pieces of loose plastic inside their Bumble Bee packages. The federal agency noted in its release that it hasn't received any reports of people getting hurt or sick as a result.

The recall is a Class II, which means there is a "remote probability of adverse health consequences," according to the Food Safety and Inspection Service.

Meanwhile, two unrelated and separate but potentially more dangerous recalls announced late last week were categorized as Class I, equating to a "reasonable probability that the use of the product will cause serious, adverse health consequences or death."

Federal food safety authorities said Friday that Diana's Mexican Food Products, of Lawndale, California, is recalling 41,670 pounds of chicken tamales.

The tamales contain whey, a known allergen. But the packages don't note the whey on its labels, said the Food Safety and Inspection Service, potentially imperiling consumers.

The tamales, which went out to restaurants in California, were produced between February and December 2, 2010. There are no known reports of adverse reactions to the undeclared presence of whey, which was discovered by federal authorities in a "routine inspection."

One day earlier, Brooklyn-based N.Y. Gourmet Salads recalled various meat and poultry products because, prior to their distribution, they hadn't been inspected by federal health inspectors.

While there have been no reports of sicknesses, a public health alert was issued October 30 for a host of Gourmet Salad's products packaged between March 11 and October 29 of this year. The recall list includes 12 items -- ranging from Swedish meatballs to stuffed cabbage to grilled chicken -- all wrapped in 4.5-, 5- and 6-pound packages.

Experts sound hepatitis alert

Deceased liver donations account for just 0.02% of all donations, for which many people needing a liver transplant die because they cannot find a donor. "The demand for new transplants is as high as 50,000 a year, but India meets hardly 10% of the need," said Dr S.K. Sarin, director, Institute of Liver and Billiary Sciences (ILBS), Vasant Kunj, on Saturday. "Hepatitis is the most common cause for liver failure and to prevent it, the health ministry should include hepatitis vaccination as part of its national immunization programme."

Compulsory hepatitis vaccination is done in some states. "Delhi is among the first states that made it mandatory to immunize a child against hepatitis infection in 2000 but even a decade later, most states are still to follow suit," said Dr Sarin, speaking on Hepatitis Day.

However, 90% of Delhi's population is not yet vaccinated against Hepatitis B, which kills more people than HIV/AIDS, Delhi health minister Kiran Walia said on Saturday.

Hepatitis A and E, which spread through contaminated food and water, are the most common cause of acute liver failure.

"Of all children suffering from Hepatitis A, there is chance that 0.1% will develop acute liver failure but 30% of them will die," said Dr Anupam Sibal, pediatric liver specialist and medical director, Apollo Hospital.

Dr Sibal stressed the need for preventive measures besides immunization.

Ashok K Chauhan, founder president, Amity Group, announced the launch of Amity Foundation for Hepatitis Prevention and Control to supplement government efforts to check the spread of disease.